Information Transfer for Multi-Trauma Patients on Discharge from the Emergency Department

Abstract

Aim: This study aimed to improve the access, flow and consistency of trauma care information on discharge of the multi-trauma patient from the Emergency Department (ED). This was achieved by identifying best practice in this context, the communication structures that were in place, any barriers and conduits to information transfer. Strategies to overcome these barriers were then developed. Background: Communication is the cornerstone to quality care, particularly when patients transition between care providers. Communication quality is consistently identified as one of the most important factors related to errors, missed injuries, adverse events and fragmented care. Despite this, the adequacy of structures and processes used for communicating patient information is unknown. This is of particular concern for trauma patients due to the time pressure involved in their care and the number of clinicians involved at any one time. Methods: This was a multi-phase, mixed method, concurrent study. Phase 1 included a context appraisal consisting of a literature review, focus group interviews, a chart audit, staff survey and a review of national and international trauma forms. In Phase 2 an intervention was developed based on data from Phase 1. In Phase 3 the intervention was implemented. Phase 4 measured the intervention’s effect on information transfer. Results: There were complex interactions between factors that influenced information transfer; however, principles of information transfer were able to be identified, along with the creation of a minimum data set for the multi-trauma patient. There is wide variability in how patient care is documented, showing little current standardisation internationally. The strategy developed to improve information transfer focussed on identifying information that should be handed over at patient transition points; raising staff awareness of barriers/conduits to information transfer; and implementation of tools such as a handover template to assist staff when recording information and at handover, and a minimum data set required to support continuity of patient care.